Provider Demographics
NPI:1154685535
Name:KRAMER, GRETCHEN LEIGHTON (LMP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEIGHTON
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 131ST ST SE
Mailing Address - Street 2:UNIT A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-350-2158
Mailing Address - Fax:
Practice Address - Street 1:1126 131ST STREET SE
Practice Address - Street 2:UNIT A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-327-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60288042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist